The Flowers Care Home Limited

The Flowers Care Home Limited is a residential care home providing personal care to older people and people living with dementia. The Flowers Care Home Limited accommodates 23 people in one adapted building. At the time of our inspection there were 14 people using the service.

People’s experience of using this service and what we found

The service had an inconsistent approach that sometimes put people’s safety and well-being at risk. The provider did not always manage risks well. Medicines were not always managed safely.

Staffing levels were generally safe although staff were sometimes stretched.

Robust recruitment checks were completed before staff started working at the service. The service had systems which safeguarded people from abuse.

The provider promoted safety through good hygiene practices and the service was regularly cleaned. The provider’s approach to visiting did not meet government guidance when we carried out our first site visit because they were restricting visitors. The registered manager took swift action to address this.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service usually supported this practice.

There was a lack of consistency in how well the service was managed. Care was not always person centred. Systems to assess and monitor the service were not always effective and did not drive the required improvements. Care recording was inconsistent and did not always provide important information about how people’s needs were being met.

Feedback about the management team and staff was generally positive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 10 August 2022). The service remains rated requires improvement. This service was rated requires improvement at the last inspection and the inspection in October 2019. This service was rated inadequate at the inspection in October 2021.

Why we inspected

The inspection was prompted in part due to concerns received about staffing arrangements, and management of risk and medicines. A decision was made for us to inspect and examine those risks.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Flowers Care Home Limited on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to risk management, medicines management and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Flowers Care Home is a residential care home providing personal care for up to 23 older people and people living with dementia. On the first day of our inspection there were 14 people using the service. On the second day of our inspection there were 13 people using the service.

People’s experience of using this service and what we found

The provider had taken positive action to address the issues from the last inspection. They had made improvements to the way the quality and safety of the home was monitored. The registered manager had introduced a range of audits. This meant they had increased oversight of the home and were able to identify areas requiring attention. Improvements were required to ensure the systems highlighted all shortfalls promptly. The registered manager demonstrated their commitment to ongoing improvement.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. We have made a recommendation about improving documentation to ensure people’s involvement is reflected fully.

Care plans contained person-centred information and risks to people’s health and safety were assessed. Improvements were required to ensure risk assessments were more detailed and were updated promptly where people’s needs changed. Medicines were managed safely. The home worked in close partnership with professionals to ensure people’s health needs were met.

People’s care needs were assessed, and they received good quality care from consistent staff who knew them well. There were enough staff on duty to meet the needs of the people currently using the service, and they had the skills to support people appropriately. Staff were committed to providing person centred care to people. They received support, supervision and training to carry out their role. Recruitment was managed safely.

People who used the service and relatives provided consistent positive feedback about their experiences of the care and support provided at The Flowers. One relative said, “The care is lovely. The staff are lovely.”

The registered manager was approachable and visible. They had initiated changes which had led to a range of improvements for people and staff. The registered manager and staff team were responsive to feedback throughout the inspection and demonstrated their commitment to ongoing improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for the service was inadequate (published 29 November 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 29 November 2021. During this inspection the provider demonstrated that improvements had been made. The service was no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced focused inspection of this service on 14 and 19 October 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Flowers Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Flowers Care Home is a residential care home providing accommodation and personal care to 23 people including people living with dementia. On the first day of the inspection there were 17 people living at the home. On the second day of the inspection there were 16 people living at the home.

People’s experience of using this service and what we found

People were not safe. They were at risk of harm because risks to their health and safety were not managed effectively. Medicines were not managed safely. People’s nutritional needs were not always met. Government guidance on the prevention and control of infection was not always followed which meant people were put at increased risk. Staff were not carrying out regular testing for COVID-19.

There were not always enough staff to keep people safe. We saw staff were kind and compassionate, but they were rushed, and routines were often task orientated. Staff were not always able to respond quickly where people needed care, support or comfort.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Most people and relatives felt people were safe and described staff as being kind and helpful.

The home and grounds were accessible.

Staff received induction, training and supervision to carry out their role. The staff team was consistent and experienced, and they knew people well and we observed warm and caring interactions. Recruitment was managed safely.

Systems to assess, monitor and improve the service had not been effective and there was a lack of management oversight to monitor day to day events and the safety of care. Audits and checks had not identified shortfalls. Opportunities to learn lessons and make improvements to the service had not been taken. Staff and relatives spoke positively about the registered manager and said they were approachable and supportive.

The provider was responsive to inspection findings and responded during and after the inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for the service was requires improvement (published 23 January 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The provider has taken action to mitigate the risk. They completed an action plan the day after the inspection and took immediate action to safeguard people, including increasing the staffing levels on an afternoon and night shift.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Flowers Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, consent to care, nutrition, staffing and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The Flowers is a residential care home providing personal care to 23 people and specialises in the care of people living with dementia. Most people who use the service are aged 65 or over. At the time of our inspection there were 17 people living at the home.

People’s experience of using this service and what we found

People’s medicines were not always managed safely. There was no evidence of harm, but people were at risk of not always receiving their medicines as prescribed. We found the provider was in breach of regulation.

There were enough staff to keep people safe. However, there were times when staff were busy and appeared rushed. This had not led to people experiencing unsafe care and we saw staff were always kind and patient when supporting people. We recommended the provider keep staffing numbers under review and ensure they were changed to take account of people’s changing needs.

Improvements were needed to the way the provider checked the quality and safety of the services provided. The checks they carried out were not always effective in identifying shortfalls and areas for improvement.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff knew people well and respected their privacy and dignity.

People’s dietary needs and preferences were catered for. The service worked with other professionals such as the district nurses to make sure people’s health care needs were addressed.

People’s needs were assessed, and their care plans included information about their needs and preferences. This supported the delivery of person-centred care. People were supported to take part in a range of appropriate activities inside and outside the home.

The home was clean and decorated in a homely style.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 27 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Our last inspection took place on 16 June 2015 and at that time we found the home was not meeting two of the regulations we looked at. These related to ‘safe care and treatment’ and ‘good governance’. The service was rated ‘Requires Improvement’ overall. This inspection was therefore carried out to see if any improvements had been made since the last inspection.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found care records were regularly updated and staff were provided with the information they needed to meet people’s needs. People’s care and treatment was planned and delivered in a way that was intended to ensure their safety and welfare.

Robust recruitment procedures were in place which ensured only staff suitable to work in the caring profession were employed. Staff received the training, support and supervision they needed to carry out their roles effectively.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA). Staff were able to tell us how they supported people to make their own decisions and the registered manager was aware of the process to follow should a person lack the capacity to consent to their care and treatment.

We saw staff had received training in safeguarding adults and were aware of the correct action to take if they witnessed or suspected any abuse. Staff were aware of the whistleblowing policy (reporting poor practice) in place and told us they were certain any concerns they raised would be taken seriously by the registered manager.

Staff encouraged and supported people to lead their lives as independently as possible whilst ensuring they were kept safe. People’s medicines were managed in a safe way. Accidents and incidents were recorded and action taken to reduce the risks to people.

We found the registered manager and staff we spoke with were able to tell us about the people who used the service, knew their likes and dislikes and things that were important to them. Staff supported people nutritional and hydration needs and ensured they had access to other health care professionals when needed.

There was a robust quality assurance monitoring in place to help improve the quality of the service provided. The provider actively sought, encouraged and supported people's involvement in the improvement of the service.

There was a complaints procedure for people to voice their concerns. People who were able and/or their relatives told us they had no complaints but were confident that they would be listened to and action would be taken to resolve any problems they may have in the future.